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Technology Brings Specialists to Distant Ships at Sea

By Douglas J. GillertAmerican Forces Press Service

BETHESDA, Md., Feb. 25, 1998  Dr. (Cmdr.) Nancy Bakalar studied her patient carefully, seeing him from her perspective as a Navy psychiatrist. She watched how he held his body, saw the military creases in his uniform shirt, the shine on his shoes.

"He was depressed, but I knew this guy was still highly motivated," Bakalar said. "He wasn't just speaking it, he was enacting it."

What made this apparently routine mental health evaluation remarkable is that Bakalar and her patient were thousands of miles apart when they "met." Bakalar assessed her patient from the telemedicine clinic at the National Naval Medical Center, here. The sailor was aboard the USS George Washington, an aircraft carrier deployed to the Persian Gulf, 3,000 miles away.

Bakalar and her husband, Dr. (Cmdr.) Richard Bakalar, chief of telemedicine here and special telemedicine assistant to the Navy surgeon general, have done much to alleviate reservations many mental health experts had about using videoteleconferencing to evaluate their patients. "Psychiatrists look at every fluctuation of the eyes, fidgets when you ask certain questions, that sort of thing," Nancy Bakalar said. "They weren't sure they could accurately view their patients on a TV monitor."

The Bakalars, however, have learned first-hand just how conducive videoteleconferencing is to mental health evaluations. "You can see tears, you can see a slowing down if they're depressed or agitation if they're anxious. You can see how they hold their body," she said.

And by using camera angles and focal distances, doctors can observe their patients from a distance, or zoom in close to make the contacts more personal, she added.

Dr (Capt.) Michael Krentz was one of the early skeptics. Senior medical officer aboard the George Washington, Krentz said he wondered whether a telemedicine "doctor's appointment" would seem artificial to patients.

"But then I realized that, for the current generation of sailors, interactive video is not novel," Krentz said. "These are guys that play video games, arcade games. There's no question that the quality of the interaction they have experienced emotionally is very real. It means a lot to sailors who may feel undervalued to know their command is so invested in their mental health it's willing to use this technology to assist them."

Mental health accounts for about a fourth of the "air" time dedicated to telemedicine aboard ship, Krentz said. Each session typically lasts 20 to 40 minutes, although some have gone as long as 90 minutes. It depends on the quality of the satellite link-up, the captain said.

Conducting mental health evaluations through videoteleconferencing saves time and keeps the sailors on ship. Without telemedicine, sailors requiring help from medical specialists would have to be evacuated to land-based hospitals and could be gone for weeks at a time. Knowing he can keep more people fit and ready for duty led one battle group commander to label telemedicine a "vital tactical support system."

For Krentz and the George Washington, telemedecine depends on support from line officers. After all, the same technology used to connect patients with medical specialists back in the states launches multi-million dollar F/A-18s and allows the admiral to command his battle group.

But when Chief of Naval Operations Adm. Jay Johnson visited the George Washington Christmas Day 1997, he said telemedicine is here to stay, Krentz recalled. "Our commanding officer clearly understands the benefit, too," he said, "and the battle group commander has seen what we've done over the last four years and has become a proponent as well."

Krentz compares telemedicine with the benefits of having a fully equipped hospital on board ship. Before telemedicine, he said, doctors aboard ships at sea were "pretty much on our own, surrounded by water, and did the best we could. If we had a problem we didn't know how to take care of, we tried to figure out the best way to get the patient off ship to a specialist somewhere.

"This is so much more like what you'd expect if you were assigned to a shore command. And why should it be any different because we're deployed? The technology is there; we should take advantage of it."

Krentz has found few limitations to telemedicine. "Most of the things we've tried have worked," he said. Videoteleconference consultations the George Washington has used include eye exams, ultrasounds, even surgical procedures. Richard Bakalar recalled a partial amputation of a finger doctors aboard the ship performed after a consulting orthopedic physician at the Portsmouth, Va., Naval Hospital examined the finger through the video and determined it wasn't salvagable.

"The primary purpose of telemedecine is to bring the resources of the naval hospital to the deck plates of a ship," Krentz said. "We don't have the resources or the logistics to bring all these specialists out on a six-month deployment. But with this technology, I've got them literally at my beck and call.

"The benefit is to the 5,000 sailors on the ship who have access to that level of care that they didn't have before."